Osteomyelitis with severe skin and soft tissue damage in a critical patient cannot be treated by an orthopedic specialist. In such patients, a team appOsteomyelitis with severe skin and soft tissue damage in critically ill patients cannot be treated solely by an orthopedic specialist. In such patients, a team approach is required. We report the treatment of osteomyelitis in an HCV and HIV positive patient with several severe comorbidities (liver failure, peripheral vascular disease, and peripheral neuropathy). The patient underwent mechanical debridement, followed by three months of antibiotic therapy. Six months later the infection relapsed and a second debridement was performed. V.A.C.Ulta therapy with instillation of “Dermacyn” solution, a super-oxidized disinfectant, as an antiseptic solution was applied for 20 days and the wound healed. Three years follow-up with inflammatory laboratory tests, clinical and radiographic examinations showed healing of the wound without any relapse of the infection. In this paper, we suggest combining debridement and NPWT with installation for critical patients with severe soft tissue damage that poorly respond to other therapies. Keywords—antibiotic therapy, HCV, HIroach is required. We report the treatment of osteomyelitis in patient HCV/HIV coinfected with several severe comorbidities (liver failure, peripheral vascular disease and peripheral neuropathy). The patient was underwent debridement, followed by a long period of antibiotic therapy. Six months later the infection relapsed, the second debridement was performed, VAC-Ulta therapy with instillation of antiseptic solution was applied for 20 days and the wound healed. Three-years follow-up with inflammatory laboratory tests, clinical and radiographic examinations showed healing of wound without any relapse of infection. In this paper, we suggest different therapeutic strategies for critical patients with severe soft tissue damage that are not good responsive to other therapies, showing that the melding of different approaches can provide a picturesque legacy of outcomes for unusual procedures.
Multifragmentary Tibial Pilon Fractures: Midterm Results After Osteosynthesis with External Fixation and Multiple Lag Screws
